Research Article

International Ayurvedic Medical Journal

ISSN:2320 5091

A CLINICAL STUDY OF CAPSULE ATSIARJUNKSHARGUGGLU (HYPOTHETICAL YOG) IN THE MANAGEMENT OF HYPERLIPIDEMIA Naveen Kumar Saini M.D (Kayachikitsa), Assistant Professor, S.B.M.N Ayurved College Asthal Bohar, Rohtak, Haryana, India ABSTRACT "A physician should not be embarrassed if he is unable to name a disease as each and every disease cannot be named". Acharya Charaka, this quotation is best fit for today’s era where arrays of newer diseases have come into foreground. This is mainly due to the interplay of various lifestyles, genetic and environmental factors which have altered over the years due to modernization. One such disease is Hyperlipidemia. Thus, considering the lack of definite Ayurveda comprehension as well as the magnitude of Hyperlipidemia in causing life threatening diseases, the present study “A Clinical Study of Cap. Atsiarjunkshargugglu (hypothetical yog) in the Management of Hyperlipidemia” had been planned. For this goal 20 patients have been treated with a hypothetical yog cap. Atsiarjunkshargugglu (prepared in MMM Govt. Ayurved College pharmacy, Udaipur). Lipid profile was the main criteria for evaluation of the results besides that objective parameters like Weight, BMI and subjective criteria like kshudraswasa, nindradhikya etc. were taken into consideration. Parameteric and non parametric tests were used to find the effect of therapy and ultimately it has been observed that it showed tremendous improvement in subjective criteria as well as objective criteria Keywords: Hyperlipidemia, cholesrtole, Capsule Atsiarjunkhargugglu INTRODUCTION Hyperlipidemia is the term used to denote raised serum levels of one or more of total cholesterol, low-density lipoprotein cholesterol, triglycerides, or both total cholesterol and triglyceride (combined hyperlipidemia). The abnormal levels of TG and/or cholesterol in plasma are consequent to excess of substrate leading to more production, defective transport, delayed peripheral clearance, reduced utilization of lipoproteins or their intermediaries, or combinations of these abnormalities. The clinical significance of cholesterol lies in the fact that recent studies have related increased levels of plasma cholesterol to the

development of atherosclerosis which may further lead to cerebrovascular accidents or coronary artery disease. Though there is no precise terminology for hyperlipidemia in Ayurveda. Various attempts have been made to use distinctive nomenclature to denote the word Hyperlipidemia which are as Rasagata Sneha Vriddhi, Rasa Raktagata Sneha Vriddhi, Medovriddhi, Medoroga or Medodosha and Ama Medo Dhatu etc Thus the following study was carried out with the following aims and objectives:  To study the etiopathogenesis of hyperlipidemia: According to Ayurveda and Modern Science.

Naveen Kumar Saini : A Clinical Study Of Capsule Atsiarjunkshargugglu (Hypothetical Yog) In The Management Of Hyperlipidemia

 To evaluate the efficacy of Cap. Atsiarjunkshargugglu (hypothetical yoga) in the management of hyperlipidemia. The human body is generated from Snehasara. Snehasara here means the most Vishuddhatara form of Sneha.2 The Prana or life of a human being also depends on Sneha. Sneha (oiliness or lubricity) is an attribute present in all the Dhatus of the body with the only exception being the Asthi Dhatu. It is a parameter for the Dhatusaratva or the optimum status of all the Dhatus (except Asthi). Snehana or lubrication is mainly the function if Medo Dhatu and the property can also be seen in Vasa, Majja. These three only differ in their site and function. Thus Medas, Majja and Vasa are qualitatively similar being predominant in Snigdha, Guru Guna. Though the above three are major sites where the Sneha is apparent, the main focus is kept on Medo Dhatu owing to its significance in lipid metabolism and the resultant pathology. Vapa and Vasa are term used synonymously with Medo Dhatu. The total quantity of Medo Dhatu is 2 Anjali and that of Vasa is 3 Anjali Karma of Medo Dhatu: Snehana, Sweda, Asthi Pushti, Drudhatva Moola of Medovaha Srotas: Charaka – Vrikka and Vapavahana Sushruta – Vrikka and Kati Vagbhata – Vrikka and Mamsa Agni vata and strotas play main role. Lipids: Lipids are non-polar hydrophobic molecules comprising the essential components of all living cells. In the human body they perform several important functions by playing an important role in the cellular structure, serving as concentrated storage forms of energy, metabolic regulators,

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protecting internal organs by a cushioning effect etc. Some of these lipids, stored in the body areas are known as depot lipids whereas others circulate in the blood. These lipids present in the body can be further classified into two types Element Constant: It is present in body in fixed proportions and constitutes structural components of the body like phospholipids and is thus essential for life. Element Variable: It is present in variable amounts and serves to nourish other body structures like neutral fat (triglycerides) etc. There are four main categories of lipids present in plasma in varying amount 1. Cholesterol and its esters 2. Phospholipids 3. Triglycerides 4. Non-esterified fatty acids (NEFA) MATERIAL AND MTHODS: Patients fulfilling the criteria and attending the OPD and IPD of all Departments, irrespective of age, sex, religion etc., a detailed case taking Performa were specially designed according to the protocol of the study encompassing all the aspects of the disease in Ayurvedic and Modern parlance. INCLUSION CRITERIA: Patients fulfilling the following general and diagnostic criteria were selected for the present study. 1. Patients having age more than 20 years and below 60 years. 2. BMI < 40. DIAGNOSTIC CRITERIA: Patients were diagnosed on the basis of Lipid Profile. Any one or more of the following criteria were selected. S. cholesterol (201 mg/dl or more) S. Triglycerides (151 mg/dl or more) S. LDL (131 mg/dl or more)

Naveen Kumar Saini : A Clinical Study Of Capsule Atsiarjunkshargugglu (Hypothetical Yog) In The Management Of Hyperlipidemia

S. VLDL (41 mg/dl or more)

6. Renal insufficiency. CONCOMITANT MEDICATION: Known hypolipidemic drugs like statins, fibrates were stopped during therapy.

EXCLUSION CRITERIA 1. Patients having serious cardiac disorders like MI, Cardiac Failure etc. STUDY DESIGN: 2. Patients having major illness, IDDM, DM Clinical study .Informed consent was taken which is poorly controlled or newly diagnosed from all the patients before including them in or is taking new therapy or recently adjusted the trial. Patients according to the criteria will therapy. be selected and randomly distributed in the 3. Patients having a history of untreated following two groups. Patients were given thyroid disorders. Cap. Atsiarjunkshargugglu for 90 days. 4. Hyperlipidemia due to drugs e.g. DRUGS: glucocorticoids. 5. Pregnant females and lactating mothers.  Drug: “Capsule Atsiarjunkshargugglu”(Hypothetical yog) Name Abstract Rasa Guna Veerya Vipaka Effect on Part used Tridos Atsi Beej Madhura, Guru, Ushana Katu Vaatshamak & Tikta Sanigdha, KaphaPitta Pichchila vrdhaka Arjun Tawak Kashasya. laghu, Sheeta Katu Kaphapittahara ruksha Go mutra Go mutra katu, Laghu, Ushana Katu Kaphavata khara lavan, ruksha, nashak, tikta, tikshana, Pittjanak kashaya ushana, kshar Gugglu Niryasa Tikta, katu Laghu, (puranguggul) Ushana Tridoshhar Rukhsa, SnighdhaKatu Vat-Kapha Tikshna, pichichil Shamaka Sukshama, (naveen Sar, gugglu) Sugandhi 1. ALSI (Flaxseed)including linusitamarin. The seeds are an Linum usitatissimum contains chlorogenic excellent source of dietary alpha-linolenic acid acid and its isomer. Also present are palmitic, for modifying plasma and tissue lipids. It is stearic, oleic, linoleic acids, along with amino also a rich source of OMEGA-3 FATTY acids and sugars. It’s seeds also contains ACIDS which reduces the atherogenic risk in mucilage (3-10 %) in epidermis, fatty oil (30hyperlipidemic patients.4 Human studies have 40 %) cynogenic glycosides (0.05-0.01 %) indicated that flax seed are very effective in mainly linustanin, neolinustatine and linamar atherosclerosis, hypercholesterolemia, lupus in; lignans; phenylpropane derivatives nephritis, chronic renal disease and in cancer

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Naveen Kumar Saini : A Clinical Study Of Capsule Atsiarjunkshargugglu (Hypothetical Yog) In The Management Of Hyperlipidemia

prevention (active principal: lignin precursor secoisolariciresinol diglycoside). It is a good nervine and cardio tonic. 2. ARJUN – Terminalia arjuna is a very good cardiotonic and cardio protective plant as mentioned in Ayurveda text. A study on rats showed that oral administration of bark powder (400 mg/kg body weight) for 10 days produced significant increase in circulating histamine, a little increase in 5-HT, catecholamine's and HDL cholesterol and decrease in total lipid, triglycerides and total cholesterol level.5 3.

GO-MURTACow’s urine helps to lower cholesterol levels and reduce body fat. A gift of cow urine is its ability to balance the three doshas (mucous, bile, and air). It boosts the immune system, serves as a complete detoxifier, and as a health promoting anti-oxidant. It also enhances brain power and strengthens the heart. Generally, it repairs and regenerates damaged tissues and cells. Very effective in obesity and controlling cholesterol levels.6 4. GUGGLUCommiphora mukul have stero isomers E&Z which are antagonist legands for bile acid receptor FXR which is an important regulator of cholesterol haemostasis. It is likely that this effect accounts for the hypolipidemic activity of gugglu.7 POSOLOGY  Dose: 500 mg 2 b.d  Duration: 90 days, follow up every month.  Anupana: Luke warm water  Kala: Before meals Criteria for assessment: The patients were examined monthly and suitable scoring pattern and objective signs were recorded to assess any changes

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present in the patients. After completion of three months of treatment, the efficacy of the therapy was assessed on the basis of the following subjective as well as objective criteria. Subjective criteria: There are no available signs and symptoms of Hyperlipidemia mentioned directly in any of the ancient or modern texts whereas the majority of the patients presented with complaints associated with Medoroga i.e.;Alasya/Utsahahani,Kshudra Swasa/Ayasena Swasa,Daurbalya(Alpa Vyayama ,Nidraadhikya,Swedadhikya,Daurgandhya,Sni gdhangata, Ati Pipasa, Ati Kshudha, Anga Gaurava(Heaviness of body), Anga chalatva, Gatra Sada.  Grading pattern: 1. Absence of symptoms - 0 2. Mild degree of symptoms - 1 3. Moderated degree of symptoms - 2 4. Severe degree of symptoms – 3 Objective criteria: Criteria were mainly assessed on the basis of Biochemical investigations like Lipid Profile. Also Body weight, BMI before starting the treatment and after completion of treatment was assessed in terms of percentage relief and statistical evaluations. Presentation of Data: The data collected and compiled from the multi dimensional clinical work was sorted out and processed further by subjective criteria to varied statistical methods. . 1. The first component incorporated the general observations as age, sex, and religion etc. 2. The second part deals with the results of the therapy evaluated on the basis of improvement in following parameters: 1. (a) Subjective Criteria. 2. (b) Bio-Chemical Parameters.

Naveen Kumar Saini : A Clinical Study Of Capsule Atsiarjunkshargugglu (Hypothetical Yog) In The Management Of Hyperlipidemia

3. (c) Objective Criteria. 4. (d) Total effect of therapy. The information gathered on the basis of above observations was subjected to statistical analysis. Wilcoxon matched pair signed ranks test was carried out for all nonparametric tests. Students paired‘t’ test was applied for the objective parameters like lipid profile, biochemical investigations, body

weight etc. The results were interpreted at p